From the publisher: Courting disaster

As a nation we have become adept at going to extremes to prevent the last disaster or near-disaster from occurring again. Isn’t that why we must take off our shoes in airport security lines and can’t carry more than a single one-quart baggie holding 3.4-ounce containers of liquid onboard a plane?

It’s easier to be reactive than proactive, I guess. It takes imagination and foresight to anticipate what might happen next.

Sometimes, though, a disaster in waiting stares us in the face and we continue to ignore it. That’s the case with the alarming and growing shortage of nurses in schools. The decrease in school nurses occurs at a time when more kids with serious medical issues like asthma and diabetes are requiring regular assistance during school hours.

In many schools unqualified secretaries, teachers and administrators are helping kids with insulin monitoring and injections, blood draws and even feeding tubes.

“People used to chuckle at school nursing and say ‘oh, that’s just Band-aids and Tylenol,’” Kathy Patrick, the Colorado Department of Education’s principal consultant for school health services said during an Education News Colorado podcast interview last week. “Not anymore.”

It’s only a matter of time before some awful and preventable tragedy occurs. Then the finger-pointing and hand-wringing will begin and we will all ask ourselves how did we ever let this happen?

“We think about this all the time as school nurses,” Patrick said. “The potential is there for someone to act incorrectly or not act at all and have a child end up severely injured or dead.”

Patrick said some states require districts to have nurses in all schools. Short of that, she said, districts could offer training programs for people who would like to become health aides in schools. Those people would need to be trained and supervised by a registered nurse, “but at least there would be someone in the building who has a little more expertise than the average staff person.”

This way, someone with minimal training would be helping kids with what can be tricky and delicate procedures. As Patrick told me, you wouldn’t want to be in the hospital and have the person who changes your bed performing medical procedures on you. Yet we seem comfortable, or at least blissfully unaware, that the equivalent is taking place in schools across the country every day.

The U.S. Department of Health and Human Services’ Healthy People 2020 initiative recommends one school nurse for every 750 “relatively healthy” students, Patrick said. Given nursing shortages and school budget realities, that’s probably not a realistic figure, she acknowledged. What the state would like to see is somewhere in the neighborhood of one nurse for every 1,200 students.

But look at these ratios, reported in last week’s EdNews story by Rebecca Jones:

Adams 12 – 1 nurse per 4,936 students

Aurora – 1 nurse per 1,754 students

Boulder – 1 nurse per 3,500 students

Cherry Creek – 1 nurse per 735 students

Greeley – 1 nurse per 3,271 students

The high ratios slap you in the face. But what about Cherry Creek? How has that suburban district, strapped by budget realities and shifting student demographics like other districts, managed to keep a ratio even lower than what the federal government recommends? What can Cherry Creek teach other districts about prioritizing?

District Spokeswoman Tustin Amole credits a successful $18 million mill levy election in 2008 for keeping cuts from being as deep in Cherry Creek as in some Denver area districts. For the most parting, staffing at schools, other than secretaries, have been protected, though some jobs are lost to attrition.

But even before the mill levy, Cherry Creek placed a high value on nursing services in schools. “I’ve been here a dozen years and this is the way it was even before I got here,” she said.

The district averages one 911 call per day because of seizures, asthma, allergic reactions or playground accidents, Amole said. When you factor in all adults and children, “there are about 60,000 people coming in and out of our buildings every day.” About the size of Grand Junction, in other words. So nurses in schools “is something we have wanted to protect.”

What happens next is unclear. Additional budget cuts are certain, in Cherry Creek as well as all other school districts as the state ties to weather an ongoing fiscal crisis. There is no guarantee nursing services will be spared the axe in the next round of reductions, in Cherry Creek or in districts that have already pared nursing to the bone.

And so it goes until something awful happens. Then somehow the money will materialize.

5 Responses to “From the publisher: Courting disaster”

This article really needs to be brought to the forefront of the citizens and parents of Colorado. Many people do not understand the secretary calling about your child with a fever is NOT a nurse, or the opposite–understand why a school needs a nurse to begin with.
Money is found for the lobbying efforts of so many worthwhile causes–why can’t we “find” it for the health and safety, and so the future success of our most important resource?

Thanks, Alan, for highlighting this critical issue. You’re absolutely correct in encouraging and insisting that school districts address it as well. As a DPS teacher, I was horrified when the district began eliminating school nurses at each school. As you so aptly explain, a tragedy awaits if corrective action isn’t taken.

Thank you, Alan, for spotlighting this critical issue. We live in Colorado. We have respect for the need our children have for psychological support because tragedy has visited our schools. During the past ten years Medicine has found treatments that has saved the lives of many more children. Now those children attend local schools. The medical treatments that are required has changed the responsibility of the School Nurses. Many more children use daily medicatons. The number of Diabetic children has exploded and many use specialized electronic delivery systems that are very complicated. Life threatening food allergies abound. Every child deserves a Nurse who can recognize the toxic effects of medications, deliver the necessary treatments, and keep our children safe. Colorado does not need to suffer tragedy to know professionals are needed in our schools. The attendance and learning of a child is foundationally based on the child’s health. School nurses are uniquely able to help healthy child stay in class, adjust the ailing child to they return to learning in the classroom and send home the ill child. During these years of economic trials and high numbers of uninsured or underinsured children, the school nurses are teaching and guiding parents and advising them so they can best support the health of their children. I commend Colorado and especially the Cherry Creek School District for having School Nurses work directly with students instead of in an delegatory or supervisory capacity. We want successful students, so we need to increase the basic supports they need. We can’t afford to be without School Nurses!
Jean Nofsinger RN
School Nurse for Cherry Creek Schoolsmnofsinger@cherrycreekschools.org

I too appreciate your highlighting of this critical issue- and I for one really hope this issue will be taken seriously by Colorado school districts- before something terrible happens. Another fact not to be ignored, particularly by the fiscally concerned- While educational lawsuits are relatively rare and sometimes result in a cost to the district of sometimes hundreds of thousands of dollars. Medical lawsuits, particularly when children are involved, are a much more regular occurrence and can result in settlements/costs in the millions. In this case, an ounce of prevention really is worth a pound of cure.

I am one of those unqualified secretaries that dispenses band-aids and ice packs. I have helped kids monitor their blood sugar and even given nebulizer treatments which I felt unqualified to do. I have been trained to give epi-pens and prescribed medication, have been certified in first-aid and CPR, but I would really feel inadequate if I was asked to take care of diabetics with insulin pumps, or if I had to check tubes or give other important medical care. There is a reason that I didn’t become a nurse and I don’t want to pretend to be one now. These are our children. We should not be putting their health care into the hands of unqualified people.